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Karic, Uros, Ivana Pesic-Pavlovic, Goran Stevanovic, et al. "FIB-4 and APRI scores for predicting severe fibrosis in chronic hepatitis C - a developing country's perspective in DAA era." Journal of Infection in Developing Countries 12, no. 03 (2018): 178–82. http://dx.doi.org/10.3855/jidc.10190.
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Introduction: Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibrosis staging necessary in the evaluation of such patients. Different fibrosis scores are emerging as possible non-invasive alternatives for liver biopsy. The Fibrosis-4 Index (FIB-4) and AST to Platelet Ratio Index (APRI) scores are the most widely used and the most extensively tested. This study aims to determine if it was possible to accurately use these to identify patients that are unlikely to have severe fibrosis.
 Methodology: One hundred and forty-two patients with chronic hepatitis C infection who underwent liver biopsy since January 1st 2014 until May 31st 2017 at the Hospital for Infectious and Tropical Diseases in Belgrade were analyzed. The FIB-4 and APRI scores were calculated for each patient and compared to histologically determined fibrosis stage.
 Results: A comprehensive statistical analysis was conducted in order to compare patients with and without severe fibrosis and to evaluate the accuracy of the fibrosis scores. Patients with non-severe fibrosis were younger, had higher platelet counts and lower transaminase levels. FIB-4 had an AUC of 0.875 and the APRI score had an AUC of 0.861. No patients with severe fibrosis or cirrhosis had a FIB-4 lower than 1.08. FIB-4 was superior to APRI in identifying patients with severe fibrosis in the study cohort.
 Conclusion: FIB-4 was superior to APRI in the recognition of severe fibrosis. FIB-4 may prove very useful in identifying patients without advanced liver disease, especially if other non-invasive methods are inaccessible.
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Kumar, Dinesh, Mukulesh Gupta, Kumar Praful Chandra, et al. "FIB-4 score is correlated with liver fibrosis but not with liver steatosis : A Cross-Sectional Study in T2DM patients." International Journal of Medical Science and Clinical Invention 12, no. 01 (2025): 7526–35. https://doi.org/10.18535/ijmsci/v12i.01.01.
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Aim: The present study was conducted to evaluate the corelation between Fibrosis-4 score (FIB-4) in cases of Liver fibrosis as well as Liver steatosis in comparison to other liver fibrosis assessment scores. Methodology: Cross-sectional study was conducted amongst 352 participants who had type 2 diabetes mellitus (T2DM). FIB-4 score and Non-alcoholic fatty liver disease fibrosis score (NFS) were calculated using blood parameters and Liver Stiffness Measurement (LSM) scores along with Controlled attenuation parameter (CAP) scores were calculated using Vibration Controlled Transient Elastography (VCTE). Spearman’s correlation estimates were used to evaluate these fibrosis scores of FIB-4, NFS and LSM in Metabolic dysfunction associated steatotic liver disease (MASLD) patients. Results: Out of a total cohort of 352 persons, 75% had steatosis and 27.1% had fibrosis based on the findings of VCTE. According to prediction based on FIB- 4, 10.8% had fibrosis, and based on the NFS fibrosis score 23.4% had fibrosis. Our data revealed a positive correlation between the FIB-4 score and LSM by VCTE (r = 0.22, p < 0.001). Conclusion: Beyond its risk assessment, FIB-4 serves as a prognostic biomarker with clinical significance. This straightforward scoring system can act as an early warning signal, helping to identify patients who are at risk for advanced liver fibrosis and may need referral to specialized medical care.
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Aydın, Cihan, Nadir Emlek, and Elif Ergül. "Liver fibrosis scores and coronary artery ectasia." Kardiologiia 63, no. 7 (2023): 62–67. http://dx.doi.org/10.18087/cardio.2023.7.n2258.
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Background. Although scoring systems showing liver fibrosis using non-invasive methods have been accepted as effective tools for predicting cardiovascular risk, their role in predicting coronary ectasia (CAE) has not been evaluated. This study investigated whether aprison (APRI) and fibrosis-4 indices (FIB-4), which are indicators of fibrosis in nonalcoholic fatty liver disease (NAFLD), are associated with CAE.Material and methods. A retrospective, cross-sectional study consisted of 215 patients, 108 with CAE and 107 without CAE, as diagnosed by angiography. The mean age of all patients was 61.8±9.9 yrs, and 171 (78.8 %) were males. The relationships between APRI, FIB-4, NAFLD, and Bard scores and CAE were evaluated.Results. APRI, FIB-4, NAFLD, and Bard scores were independent predictors of CAE. Fib 4, APRI, NAFLD, and Bard scores were higher in the CAE patients. There were a moderate, positive correlations for FIB-4, APRI, and NAFLD scores with coronary ectasia (r=0.55, p<0.001; r=0.52, p<0.001; r=0.51, p<0.001, respectively). A weak-moderate positive correlation was observed between the Bard score and CAE (r=0.34, p<0.001). Univariate and multivariate regression analysis showed that APRI score, low HDL, and Bard score were independent risk factors for CAE ectasia (p<0.001). Cut-off values to predict CAE as determined by ROC curve analysis were: FIB-4 index ≥1.43 (AUC=0.817, 95 % confidence interval (CI): 0.762 to 0.873, p<0.001), APRI index ≥0.25 (AUC=0.804, 95 % CI: 0.745 to 0.862, p<0.001), NAFLD score ≥–0.92 (AUC=0.798, 95 % CI: 0.738 to 0.857.p<0.001), Bard score ≥2 (AUC=0.691, 95 % CI: 0.621 to 0.761, p<0.001).Conclusion. APRI, FIB-4, NAFLD, and Bard scores are associated with CAE.
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Cox, Ben, Roberto Trasolini, Ciaran Galts, Eric M. Yoshida, and Vladimir Marquez. "Comparing the performance of Fibrosis-4 and Non-Alcoholic Fatty Liver Disease Fibrosis Score with transient elastography scores of people with non-alcoholic fatty liver disease." Canadian Liver Journal 4, no. 3 (2021): 275–82. http://dx.doi.org/10.3138/canlivj-2021-0004.
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BACKGROUND: With the rate of non-alcoholic fatty liver disease (NAFLD) on the rise, the necessity of identifying patients at risk of cirrhosis and its complications is becoming ever more important. Liver biopsy remains the gold standard for assessing fibrosis, although costs, risks, and availability prohibit its widespread use with at-risk patients. Transient elastography has proven to be a non-invasive and accurate way of assessing fibrosis, although the availability of this modality is often limited in primary care settings. The Fibrosis-4 (FIB-4) and Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS) are scoring systems that incorporate commonly measured lab parameters and BMI to predict fibrosis. METHOD: In this study, we compared FIB-4 and NFS scores with transient elastography scores to assess the accuracy of these inexpensive and readily available scoring systems in detecting fibrosis. RESULTS: Using an NFS score cut-off of –1.455 and a FibroScan score cut-off of ≥8.7 kPa, the NFS score had a negative predictive value of 94.1%. Using a FibroScan score cut-off of ≥8.7 kPa, the FIB-4 score had a negative predictive value of 91.6%. CONCLUSION: The NFS and FIB-4 are non-invasive, inexpensive scoring systems that have high negative predictive value for fibrosis compared with transient elastography scores. These findings suggest that the NFS and FIB-4 can provide adequate reassurance to rule out fibrosis in patients with NAFLD and can be used with select patients to circumvent the need for transient elastography or liver biopsy.
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AÇIKALIN ARIKAN, Hatice Burcu, Tuna DEMİRDAL, and Neriman BİLİR. "Kronik hepatit C’li hastaların karaciğer fibrozisini göstermede APRI ve FIB-4 skorlamalarının değeri." Cukurova Medical Journal 48, no. 2 (2023): 663–68. http://dx.doi.org/10.17826/cumj.1273431.
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Purpose: Infection with hepatitis C virus causes chronic liver damage, fibrosis and in later processes, cirrhosis and liver cancer. Currently, the use of biomarkers, instead of invasive procedures, is recommended to identify liver fibrosis. In this study, we aimed to evaluate the sensitivity and specificity of aspartate aminotransferase (AST) to Platelet Ratio Index (APRI) and Fibrosis-4 Index (FIB-4) scoring for detection of "significant fibrosis" in chronic hepatitis C patients.
 Materials and Methods: Liver biopsy results and blood test results of 50 patients, infected with chronic hepatitis C, were analyzed. APRI and FIB-4 scores were calculated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and consistency for APRI and FIB-4 scorings were calculated using a fourfold table. The values of APRI and FIB-4, providing the best specificity and sensitivity in the diagnosis of significant fibrosis, was determined by ROC (receiver operator characteristics curve) analysis.
 Results: The mean fibrosis stage of 30 patients with significant fibrosis was 2.83±0.74 and the mean patient age was 56.8±13. The sensitivity of APRI ≥ 1.5 to detect significant fibrosis was 16%, the specificity was 90%, PPV was 71% and NPV was 41%. A FIB-4 score of ≥3.25 had a sensitivity of 20%, a specificity of 95%, a PPV of 85% and a NPV of 44%. 
 Conclusion: APRI and FIB-4 have high specificity and PPV in demonstrating significant fibrosis, but have low sensitivity and NPV. The sensitivity of FIB-4 was higher compared to the APRI scoring. More research on this subject is needed, as well as revision of fibrosis scores and development of new fibrosis scores.
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Cox, B. D., R. Trasolini, C. Galts, E. M. Yoshida, and V. Marquez. "A188 COMPARING THE PERFORMANCE OF FIBROSIS-4 (FIB-4) AND NON-ALCOHOLIC FATTY LIVER DISEASE FIBROSIS SCORE (NFS) WITH FIBROSCAN SCORES IN NON-ALCOHOLIC FATTY LIVER DISEASE." Journal of the Canadian Association of Gastroenterology 3, Supplement_1 (2020): 59–60. http://dx.doi.org/10.1093/jcag/gwz047.187.
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Abstract Background With the rates of non-alcoholic fatty liver disease (NAFLD) on the rise, the necessity of identifying patients at risk of cirrhosis and its complications is becoming ever more important. Liver biopsy remains the gold standard for assessing fibrosis, although the costs, risks, and availability prohibit its widespread use for at-risk patients. Fibroscan has proven to be a non-invasive and accurate way of assessing fibrosis, although the availability of this modality is often limited in the primary care setting. The Fibrosis-4 (FIB-4) and Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS) are scoring systems which incorporate commonly measured lab parameters and BMI to predict fibrosis. In this study, we compared FIB-4 and NFS values to fibroscan scores to assess the accuracy of these inexpensive and readily available scoring systems for detecting fibrosis. Aims The aim of this study was to determine if non-invasive and inexpensive scoring systems (FIB-4 and NFS) can be used to rule out fibrosis in non-alcoholic fatty liver disease with comparable efficacy to fibroscan. Ultimately, we aim to demonstrate that these scoring systems can be used as an alternative to fibroscan in some patients. Methods Data was collected from 317 patient charts from the Vancouver General Hepatology Clinic. 93 patients were removed from the study due to insufficient data (missing Fibroscan score or lab work necessary for FIB-4/NFS). For the remaining 224 patients, FIB-4 and NFS were calculated and compared to fibrosis scores both independently and in combination. Results: Using a NFS score cut-off of -1.455 and a fibroscan score cut-off of ≥8.7kPa, the NFS had a sensitivity of 71.9%, a specificity of 75%, and a negative predictive value of 94.1%. For a fibroscan score cut-off of ≥8.0kPa, the NFS had a sensitivity of 66.7%, a specificity of 75.7%, and a negative predictive value of 91.5%. Using a fibroscan score cut-off of ≥8.7kPa, the FIB-4 score had a sensitivity of 53.1%, specificity of 84.9%, and a negative predictive value of 91.6%. For a cut-off of ≥8.0kPa, it had a sensitivity of 51.3%, and 85.9%, and a negative predictive value of 89.3%. Conclusions: The NFS and FIB-4 are non-invasive scoring systems that have high sensitivity and negative predictive value for fibrosis when compared to fibroscan scores. These findings suggest that the NFS and FIB-4 can provide adequate reassurance to rule-out fibrosis in select patients, and has promising use in the primary care setting where fibroscan access is often limited. Funding Agencies None
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Åberg, Fredrik, Mitja Lääperi, and Ville Männistö. "CLivD score modifies FIB-4 performance in liver fibrosis detection in the US general population." eGastroenterology 1, no. 2 (2023): e100035. http://dx.doi.org/10.1136/egastro-2023-100035.
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Background and aimsSteatotic liver disease (SLD) is a growing global concern. The Chronic Liver Disease (CLivD) risk score predicts liver-related outcomes in the general population using easily accessible variables with or without laboratory tests (CLivDlaband CLivDnon-lab). We assessed CLivD’s associations with liver steatosis, fibrosis and its combined performance with fibrosis-4 (FIB-4) for advanced fibrosis detection.MethodsUsing the National Health and Nutrition Examination Survey data (2017–2020), 3603 participants aged 40–70 years with valid liver stiffness measurements (LSMs) were included. Advanced fibrosis was defined as LSM ≥12 kPa, and SLD as controlled attenuation parameter ≥288 dB/m.ResultsSignificant associations were found between CLivD and SLD and advanced fibrosis. CLivDlabhad an area under the curve (AUC) for advanced fibrosis of 0.72 (95% CI 0.68 to 0.77), while CLivDnon-labhad an AUC of 0.68 (95% CI 0.64 to 0.72), both slightly higher than FIB-4 (AUC 0.66, 95% CI 0.60 to 0.72). Among participants without obesity, AUC of CLivDlabwas 0.82 (95% CI 0.76 to 0.88) and AUC of CLivDnon-labwas 0.72 (95% CI 0.65 to 0.79). The CLivD score improved FIB-4’s AUC for advanced fibrosis detection from <0.5 at minimal CLivD scores to >0.8 at high CLivD scores. A sequential CLivD→FIB-4 strategy outperformed universal FIB-4 testing, enhancing specificity from 72% to 83%, with sensitivity at 51%–53%. This strategy identified a subgroup with a 55% prevalence of advanced fibrosis, while 47% had minimal-risk CLivD scores, eliminating the need for FIB-4 testing.ConclusionsThe CLivD score, designed for predicting liver-related outcomes, effectively identifies liver steatosis and advanced fibrosis in the general population. Combining CLivD with FIB-4 enhances advanced fibrosis detection accuracy. The CLivD score could enhance population-based liver fibrosis screening, optimising resource allocation.
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Naik, B. Balakasi, Babu Kumar, and Sultan Nawahirsha Pughazhendhi. "Serum fibroscores APRI, FIB-4 and fibroscan in assessment of liver fibrosis in alcoholic associated liver disease." International Journal of Advances in Medicine 8, no. 4 (2021): 551. http://dx.doi.org/10.18203/2349-3933.ijam20211054.
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Background: Alcohol-associated liver disease includes a variety of clinical disorders which include steatosis, Alcoholic steato hepatitis, alcoholic hepatitis of varying degrees of severity, alcoholic cirrhosis, and alcohol associated cirrhosis complicated by hepatocellular carcinoma (HCC). In patients with alcoholic liver disease the presence of hepatic (liver) fibrosis and progression into cirrhosis is a prognostic variable and having impact on survival. To assess hepatic (liver) fibrosis using serum fibro scores fibrosis-4 (FIB-4) scores, AST platelet ratio index (APRI scores) and to compare these results with fibro scan to rule out severe fibrosis in patients with alcohol related disease.Methods: A cross sectional clinical study conducted on 50 patients with alcohol associated chronic liver disease between December 2019 to December 2020 who were in follow up in outpatient department (OPD) and admitted in the Department of Medical Gastroenterology. APRI and FIB-4 scores were calculated and compared with fibro scan values.Results: The results of 50 patients were analysed, including, males with a mean age. Among the study population, 6 (12%) participants had no significant FIB-4, 16 (32%) participants had intermediate FIB-4 and 28 (56%) participants had likely cirrhosis. 33 (66%) participants had no significant APRI, 6 (12%) participants had significant APRI and 11 (22%) participants had cirrhosis liver. Among the people with fibro scan KPA F0-F1 (<7), all of them 100% were no significant FIB-4. Among the people with fibro scan KPA F2 (7 To 9.50), 2 (50%) were no significant FIB-4 and intermediate FIB-4 for each respectively.Conclusions: FIB-4 score correlated better than APRI score in assessing patients with and without severe fibrosis and cirrhosis in the setting of alcohol associated liver disease patients.
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Kolhe, Kailash Marotrao, Anjali Amarapurkar, Pathik Parikh, et al. "Aspartate transaminase to platelet ratio index (APRI) but not FIB-5 or FIB-4 is accurate in ruling out significant fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) in an urban slum-dwelling population." BMJ Open Gastroenterology 6, no. 1 (2019): e000288. http://dx.doi.org/10.1136/bmjgast-2019-000288.
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Background and aimsNon-invasive assessment of fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) is challenging, especially in resource-limited settings. MR or transient elastography and many patented serum scores are costly and not widely available. There are limited data on accuracy of serum-based fibrosis scores in urban slum-dwelling population, which is a unique group due to its dietary habits and socioeconomic environment. We did this study to compare the accuracy of serum-based fibrosis scores to rule out significant fibrosis (SF) in this population.MethodsHistological and clinical data of 100 consecutive urban slum-dwelling patients with NAFLD were analysed. Institutional ethics committee permission was taken. Aspartate transaminase (AST) to platelet ratio index (APRI), fibrosis-4 index (FIB-4) and FIB-5 scores were compared among those with non-significant fibrosis (METAVIR; F0 to F1; n=73) and SF (METAVIR; F2 to F4; n=27).ResultsAST (IU/mL) (68.3±45.2 vs 23.9±10.9; p<0.0001), alanine transaminase (IU/mL) (76.4±36.8 vs 27.9±11.4; p<0.0001), FIB-4 (2.40±2.13 vs 0.85±0.52; p<0.0001) and APRI (1.18±0.92 vs 0.25±0.16; p<0.0001) were higher and platelets (100 000/mm3) (1.8±0.8 vs 2.6±0.7; p<0.0001), albumin (g/dL) (3.4±0.50 vs 3.7±0.4; p<0.0001), alkaline phosphatase (IU/L) (60.9±10.2 vs 76.4±12.9; p<0.0001) and FIB-5 (−1.10±6.58 vs 3.79±4.25; p<0.0001) were lower in SF group. APRI had the best accuracy (area under the receiver operating characteristic curve=0.95) followed by FIB-4 (0.78) and FIB-5 (0.75) in ruling out SF.ConclusionsAPRI but not FIB-5 or FIB-4 is accurate in ruling out SF in patients with NAFLD in an urban slum-dwelling population.
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Demir, Nurhan, Bilgehan Yüzbasıoglu, Turan Calhan, and Savas Ozturk. "Prevalence and Prognostic Importance of High Fibrosis-4 Index in COVID-19 Patients." International Journal of Clinical Practice 2022 (May 4, 2022): 1–8. http://dx.doi.org/10.1155/2022/1734896.
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Introduction. The fibrosis 4 (FIB-4) index was developed to predict advanced fibrosis in patients with liver disease. We aimed to evaluate the association of FIB-4 with risk factors for progression to critical illness in middle-aged patients hospitalized for coronavirus disease 2019 (COVID-19). Method. We included patients aged 35–65 years who were hospitalized following a positive RT-PCR SARS-Cov-2 test in a tertiary hospital. All data were obtained from the medical records of the patients during the first admission to the hospital. The FIB-4 index was calculated according to the equation (age (years) x AST (IU/L)/platelet count (109/L)/√ALT (IU/L)). The FIB-4 index was divided into three categories according to the score categorisation: <1.3 = low risk, 1.3–2.67 = moderate risk, and >2.67 = high risk. Results. A total of 619 confirmed COVID-19 patients (mean age = 52 yrs.) were included in this study; 37 (6.0%) were admitted to the intensive care unit (ICU), of which 44% were intubated and eight (1.3%) patients died during follow-up. The results of patients with high FIB-4 scores were compared with those with low FIB-4 scores. In patients with high FIB-4 scores, male gender, and advanced age, decreased neutrophil, lymphocyte, thrombocyte, and albumin counts, elevated AST, LDH, CK, ferritin, CRP, and D-dimer, and low GFR were the high-risk factors for critical illness. Additionally, the number of patients referred to ICU with high FIB-4 who died had higher scores than from those with low scores. Conclusion. The FIB-4 index derived from baseline data obtained during hospitalisation can be used as a simple, inexpensive, and straightforward indicator to predict ICU requirement and/or death in middle-aged hospitalized COVID-19 patients.
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Liaqat, Mahjabeen, Kashif Siddique, Imran Yousaf, Raham Bacha, S. Muhammad Yousaf Farooq, and Syed Amir Gilani. "Comparison between shear wave elastography and serological findings for the evaluation of fibrosis in chronic liver disease." Journal of Ultrasonography 21, no. 86 (2021): e186-e193. http://dx.doi.org/10.15557/jou.2021.0030.
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Aim: In this study, we sought to examine the optimal cutoff values for predicting different stages of liver fibrosis, and to determine the level of agreement between shear wave elastography and aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) scores in patients with chronic liver disease. Methodology: A descriptive, cross-sectional study was performed at the Radiology Department of Shaukat Khanum Memorial Hospital Lahore from 1 Jun 2019 until 1 June 2020. FIB-4 and APRI scores were determined by the following formula: FIB-4 = (age × AST) ÷ (platelet count × (√ (ALT)) and APRI = (AST÷AST upper limit of normal) ÷ platelet × 100. Data was analyzed with the help of SPSS version 24.0 and Microsoft Excel 2013. Results: Eighty individuals were conveniently selected, of which 62.5% were men and 37.5% were women. The mean age of the subjects was 43.47 SD ± 13.85 years. APRI and FIB-4 scores predicted F4 patients using the cutoff values of 0.47 (Sn. 72%, Sp. 70%) and 1.27 (Sn. 78%, Sp. 73%), respectively. The cutoff values of 0.46 for APRI and 1.27 for FIB-4 predicted F3–F4 patients (Sn. 74% and 77%; Sp. 76% and 76%), respectively. To predict F1–F4 compared to F0, the cutoff value was 0.34 (Sn. 68%, Sp. 75%) for APRI, while the cutoff value for FIB was 0.87 (Sn. 72%, Sp. 75%). The findings suggest that FIB-4 shows better diagnostic accuracy than APRI. Conclusion: This study provides optimal cutoff values for different groups of fibrosis patients for both serum markers. Also, the diagnostic accuracy of FIB-4 for predicting liver fibrosis was found to be superior to APRI in all disease stages.
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Ciardullo, Stefano, Emanuele Muraca, Silvia Perra, et al. "Screening for non-alcoholic fatty liver disease in type 2 diabetes using non-invasive scores and association with diabetic complications." BMJ Open Diabetes Research & Care 8, no. 1 (2020): e000904. http://dx.doi.org/10.1136/bmjdrc-2019-000904.
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ObjectiveNon-alcoholic fatty liver disease (NAFLD) is prevalent in patients with type 2 diabetes. Here, we estimate the proportion of patients with type 2 diabetes that should be referred to hepatologists according to the European Association for the Study of the Liver (EASL)-European Association for the Study of Diabetes (EASD)-European Association for the Study of Obesity (EASO) Guidelines and evaluate the association between non-invasive biomarkers of steatosis and fibrosis and diabetic complications.Research design and methodsThis is a retrospective analysis of type 2 diabetes patients who attended on a regular basis our diabetes clinic between 2013 and 2018 (n=2770). Steatosis was assessed using Fatty Liver Index (FLI), Hepatic Steatosis Index and NAFLD Ridge Score and fibrosis using NAFLD Fibrosis Score (NFS), Fibrosis-4 (FIB-4), aspartate aminotransferase (AST) to platelet ratio index (APRI) and AST/alanine aminotransferase (ALT) ratio. Outcome measures were altered albumin excretion rate (AER), chronic kidney disease (CKD) and cardiovascular disease (CVD).ResultsThe prevalence of advanced fibrosis varied from 1% (APRI) to 33% (NFS). The application of the guidelines using a sequential combination of FLI and FIB-4 would lead to referral of 28.3% of patients when using standard FIB-4 cut-offs, while this number dropped to 13.4% when age-adjusted FIB-4 thresholds were applied. A higher prevalence of altered AER was associated with liver steatosis (FLI: OR: 3.49; 95% CI 2.05 to 5.94, p<0.01), whereas liver fibrosis was associated with CKD (FIB-4: OR: 6.39; 95% CI 4.05 to 10.08, p<0.01) and CVD (FIB-4: OR: 2.62; 95% CI 1.69 to 4.04, p<0.01).ConclusionsWhile specific fibrosis scores identify different proportion of patients with advanced fibrosis, the use of age-adjusted FIB-4 cut-offs leads to a drop in gray-zone results, making referrals to hepatologists more sustainable. Interestingly non-invasive biomarkers were consistently associated with a different pattern of diabetic complications.
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Servais Albert Fiacre, Eloumou Bagnaka, Bekolo Nga Winnie Tatiana, Nsenga Djapa Guy Roger, et al. "Evaluation of liver fibrosis by non-invasive markers (transient elastography vs. APRI, FIB-4, and FORNS) in chronic hepatitis C virus carriers in a low-income country." Nigerian Journal of Gastroenterology and Hepatology 16, no. 1 (2024): 22–28. http://dx.doi.org/10.4103/njgh.njgh_3_24.
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Abstract Background: The interest in evaluating hepatic fibrosis stems from the fact that the risk of developing cirrhosis following hepatitis C virus (HCV) infection is estimated at 10%–20%. The aim of this study was to identify feasible, accessible, and affordable non-invasive methods other than transient elastography (TE) in the evaluation of liver fibrosis in a resource-limited country. Materials and Methods: This was a cross-sectional analytical study conducted over 24 months in two health facilities in Douala, Cameroon. All chronically infected HCV patients who had undergone a TE were enrolled. In this study, TE was considered the gold standard for evaluating hepatic fibrosis. Other non-invasive markers considered were the aspartate transaminase to platelet ratio (APRI) index, fibrosis-4 (FIB-4), and FORNS scores. The sensitivity (Se), specificity (Sp), positive predictive value, and negative predictive value of each marker to determine significant fibrosis and cirrhosis were calculated for different thresholds, and the best Se/Sp ratio evaluated by the area under the receiving operating characteristic curve. Results: One hundred eighty-four patients were enrolled. The mean age was 56.2 ± 10.6 years with a female predominance. There was a positive correlation between TE and the FIB-4 score, the APRI score, and the FORNS score. The threshold values to predict significant fibrosis for the FIB-4, APRI, and FORNS score were 2, 0.5, and 7.6, respectively. The threshold values to predict cirrhosis for the FIB-4, APRI, and FORNS scores were 3.2, 1.3, and 9.6, respectively. Conclusion: The FIB-4 score is the best at predicting significant fibrosis, while the APRI and FIB-4 scores are the best at predicting cirrhosis in hepatitis C patients when compared to TE as the gold standard.
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Padeniya, Padmapani, Dileepa Senajith Ediriweera, Arjuna P. De Silva, Madunil Anuk Niriella, and Anuja Premawardhena. "Using FIB-4 score as a screening tool in the assessment of significant liver fibrosis (F2) in patients with transfusion-dependent beta thalassaemia: a cross-sectional study." BMJ Open 12, no. 9 (2022): e061156. http://dx.doi.org/10.1136/bmjopen-2022-061156.
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ObjectiveTo evaluate the performance of the fibrosis-4 (FIB-4) score as a screening tool to detect significant liver fibrosis (F2) compared with transient elastography (TE), among chronic transfusion-dependent beta-thalassaemia (TDT) patients in a resource-poor setting.DesignA cross-sectional study.SettingAdolescent and Adult Thalassaemia Care Centre (University Medical Unit), Kiribathgoda, Sri Lanka.Participants45 TDT patients who had undergone more than 100 blood transfusions with elevated serum ferritin >2000 ng/mL were selected for the study. Patients who were serologically positive for hepatitis C antibodies were excluded.Outcome measuresTE and FIB-4 scores were estimated at the time of recruitment in all participants. Predefined cut-off values for F2, extracted from previous TE and FIB-4 scores studies, were compared. A new cut-off value for the FIB-4 score was estimated using receiver operating characteristics curve analysis to improve the sensitivity for F2 prediction.ResultsOf the selected 45 TDT patients, 22 (49%) were males. FIB-4 score showed a significant linear correlation with TE (r=0.52;p<0.0003). The FIB-4 score was improbable to lead to a false classification of TDT patients to have F2 when the FIB-4 cut-off value was 1.3. On the other hand, it had a very low diagnostic yield in missing almost all (except one) of those who had F2. Using a much-lowered cut-off point of 0.32 for FIB-4, we improved the pick-up rate of F2 to 72%.ConclusionsRegardless of the cut-off point, the FIB-4 score cannot be used as a good screening tool to pick up F2 in patients with TDT, irrespective of their splenectomy status. On the contrary, at a 1.3 cut-off value, though FIB-4 is a very poor detector for F2 fibrosis, it will not erroneously diagnose F2 fibrosis in those who do not have it.
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Sandvik, Elfrid Christine Smith, Kristin Matre Aasarød, Gjermund Johnsen, et al. "The Effect of Roux-en-Y Gastric Bypass on Non-Alcoholic Fatty Liver Disease Fibrosis Assessed by FIB-4 and NFS Scores—An 11.6-Year Follow-Up Study." Journal of Clinical Medicine 11, no. 16 (2022): 4910. http://dx.doi.org/10.3390/jcm11164910.
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Severe obesity is a strong risk factor for non-alcoholic fatty liver disease (NAFLD). Roux-en-Y gastric bypass (RYGB) surgery effectively induces weight loss, but few studies have described the long-term effects of RYGB on NAFLD-related fibrosis. Data from 220 patients with severe obesity operated by RYGB in Central Norway were analysed. Variables incorporated in NAFLD Fibrosis Score (NFS), Fibrosis-4 (FIB-4) index and anthropometric data were collected before surgery and a mean of 11.6 years postoperatively. FIB-4 > 1.3 or NFS > 0.675 were used as cut-off values for advanced fibrosis. Proportions with advanced fibrosis decreased from 24% to 14% assessed by FIB-4 and from 8.6% to 2.3% using NFS, with resolution rates of advanced fibrosis of 42% and 73%, respectively. The shift towards lower fibrosis categories was significant (NFS p < 0.0001; FIB-4 p = 0.002). NFS decreased from −1.32 (IQR −2.33–−0.39) to −1.71 (IQR −2.49–−0.95, p < 0.001) 11.6 years after surgery, whereas FIB-4 did not change: 0.81 (IQR 0.59–1.25) to 0.89 (IQR 0.69–1.16, p = 0.556). There were weak correlations between change in fibrosis scores and weight loss. In conclusion, the majority of patients with advanced fibrosis at baseline had improvement after 11.6 years. Factors associated with reduction in fibrosis were not identified.
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Vacheron, Albert, Anand Saha, Kevin Coughlin, A. X. Freire, and Sue Theus. "0512 Apnea-Hypopnea Index does not correlate with Non-Alcoholic Fatty Liver Disease scores." SLEEP 46, Supplement_1 (2023): A226. http://dx.doi.org/10.1093/sleep/zsad077.0512.
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Abstract Introduction Obstructive Sleep Apnea (OSA) and Nonalcoholic Fatty Liver Disease (NAFLD) are two conditions that have increased in prevalence in the United States. NAFLD is a spectrum of liver disease ranging from steatosis to non-alcoholic steatohepatitis (NASH) to cirrhosis. The purpose of this project is to study the relationship between OSA, measured by apnea-hypopnea index and/or arterial oxygen saturation nadir (O2 nadir) during sleep (independent variable) vs. extent of NAFLD as measured by non-invasive scores such as NAFLD Fibrosis score, aminotransferase to platelet ratio index (APRI), BARD score and FIB-4 score (dependent variable). Methods A convenient sample of 91 haphazardly selected veterans with OSA and NAFLD from the Veterans Affairs (VA) Computerized Record System (CPRS) system were included in the study. NAFLD eligibility was determined by abdominal ultrasound, CT scan, MRI, or biopsy. Dependent variables were NAFLD scores of APRI, NAFLD Fibrosis, BARD, and FIB-4. OSA was determined by in-lab polysomnogram or home sleep study. Independent variables were AHI, O2 nadir, age and body mass index (BMI). Patients with a history of alcohol abuse or Hepatitis B or C were excluded from the study. A multiple regression analysis was used to describe the relationship between OSA and NAFLD scores. P&lt; 0.05 was considered statistically significant. Results Age correlated with FIB-4 score, BARD score, and NAFLD fibrosis score (p = &lt; 0.001, 0.003, &lt; 0.001, respectively). BMI correlated with NAFLD fibrosis score (p &lt; 0.001). When controlled for age and BMI, AHI and O2 nadir did not correlate with APRI, NAFLD fibrosis, BARD, or FIB-4 scores. Conclusion OSA measured by AHI and O2 nadir do not correlate with severity of fatty liver disease as measured by APRI, NAFLD fibrosis, BARD, or FIB-4 scores. Support (if any) None
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Pasha, Mohammed Mahaboob, Narendra Sreekanth Tirumala, and V. R. Mujeeb. "Correlation of serum markers with FibroScan® liver for assessment of hepatic fibrosis in patients with non-alcoholic steatohepatitis." Journal of Clinical and Scientific Research 12, no. 4 (2023): 257–61. http://dx.doi.org/10.4103/jcsr.jcsr_174_22.
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Abstract Background: Newer non-invasive modalities such as FibroScan and laboratory testing methods such as aspartate aminotransferase (AST) platelet ratio index (APRI) scores, AST/alanine aminotransferase (ALT) ratio and fibrosis-4 (FIB-4) scores are being used for fibrosis assessment in non-alcoholic fatty liver disease (NAFLD) patients where facilities for liver biopsy are lacking. We studied the relationship between FibroScan® scores and serum fibrosis markers in non-alcoholic steatohepatitis (NASH) patients. Methods: One hundred patients who had undergone FibroScan of the liver over the past 2 years were enrolled. Demographic data were collected along with serum ALT, serum AST and platelet counts. The AST/ALT ratio, APRI score and FIB-4 were compared with the FibroScan fibrosis scores. Correlate between the degree of fibrosis in relation to age, platelet counts, serum ALT, serum markers and FibroScan scores was studied. Results: A significant positive correlation was noted between the FibroScan® results and the AST/ALT ratio, the APRI score and the FIB-4. No significant correlation was noted between age and fibrosis score. There was a highly significant correlation between platelet count and stiffness score. Conclusions: Our observations suggest that FibroScan®, along with the serum fibrosis markers, is helpful in assessing liver fibrosis in NASH patients, eliminating the need for liver biopsy in resource-poor settings.
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Willandra, Fitriyanri Ghaniyya, Humairah Ira, and Kholili Ulfa. "Evaluating the accuracy of APRI and FIB-4 scores in chronic HBV-related liver fibrosis: A literature review." World Journal of Advanced Research and Reviews 24, no. 3 (2024): 2680–84. https://doi.org/10.5281/zenodo.15239728.
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Chronic hepatitis B virus (HBV) infection poses significant risks to liver health, often progressing to complications such as fibrosis, cirrhosis, and hepatocellular carcinoma. Accurate assessment of liver fibrosis is essential for guiding treatment decisions and improving patient outcomes. Non-invasive scoring systems like the AST to Platelet Ratio Index (APRI) and the Fibrosis Index Based on 4 Factors (FIB-4) have emerged as reliable alternatives to invasive liver biopsy. These tools utilize readily available biomarkers to classify patients based on fibrosis severity, supporting early intervention and reducing the risks associated with traditional diagnostic methods. This review evaluates the diagnostic performance of APRI and FIB-4 in chronic HBV-related liver fibrosis. Studies indicate that while APRI is valued for its simplicity, FIB-4 demonstrates superior sensitivity and specificity, particularly in older populations. Both scores show strong correlations with histological findings and serve as effective tools for diagnosing significant fibrosis and cirrhosis. However, factors such as liver inflammation, comorbidities, and variable fibrosis distribution can influence their accuracy, highlighting the need for careful interpretation. Comparison with advanced methods like FibroScan® underscores the limitations of biochemical indices alone and the importance of combining multiple diagnostic approaches. Future research should focus on longitudinal studies and algorithm optimization to enhance the utility of these non-invasive tools. Integrating APRI and FIB-4 into clinical practice offers a cost-effective and accessible strategy for managing chronic HBV-related liver fibrosis, ultimately improving patient care and outcomes
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Ramadan, Mohammad Said, Filomena Boccia, Simona Maria Moretto, et al. "Cardiovascular Risk in Patients with Chronic Hepatitis C Treated with Direct Acting Antivirals." Journal of Clinical Medicine 11, no. 19 (2022): 5781. http://dx.doi.org/10.3390/jcm11195781.
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Background: Chronic hepatitis C (CHC) is associated with hepatic and extrahepatic complications, including cardiovascular disease (CVD). The effects of sustained virological response (SVR) and liver fibrosis on CVD risk are not well established. Aims: We aim to assess the dynamics of Fibrosis-4 (FIB-4) and Atherosclerotic Cardiovascular Disease 2013 (ASCVD) scores up to three years after direct acting antivirals (DAA) treatment and explore the time-dependent association between the two scores. Methods: We included consecutive CHC patients treated with DAA and followed up with them for three years. Outcomes were changes from baseline (before DAA) in ASCVD and FIB-4 scores, measured at the end of treatment, 12-, 24-, and 36-months follow-up. Results: In total, 91 patients with CHC were finally included (median age: 66 years (IQR = 58–72 years); 43% females). Median follow-up was 2 years (1–3 years) and all patients reached SVR. The ASCVD score did not significantly change from baseline (Mean = 17.2%, 95% CI 14.1, 20.3), but the FIB-4 score significantly decreased at any time-point by an average of 0.8 (95% CI 0.78, 0.82, p < 0.001). Elevated FIB-4 scores at one (β = 1.16, p < 0.001) and three years (β = 2.52, p < 0.001) were associated with an increased ASCVD score. Clinically, two participants- with non-decreasing FIB-4 scores after treatment- had acute coronary syndrome at the end of treatment and one year follow-up, respectively. Conclusions: In our study, we found that FIB-4 and ASCVD scores exhibited a positive correlation irrespective of time-point after treatment. Larger studies are essential to further investigate the utility of FIB-4 scores in cardiovascular risk assessment.
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Willandra Fitriyanri Ghaniyya, Ira Humairah, and Ulfa Kholili. "Evaluating the accuracy of APRI and FIB-4 scores in chronic HBV-related liver fibrosis: A literature review." World Journal of Advanced Research and Reviews 24, no. 3 (2024): 2680–84. https://doi.org/10.30574/wjarr.2024.24.3.3937.
Full textAbstract:
Chronic hepatitis B virus (HBV) infection poses significant risks to liver health, often progressing to complications such as fibrosis, cirrhosis, and hepatocellular carcinoma. Accurate assessment of liver fibrosis is essential for guiding treatment decisions and improving patient outcomes. Non-invasive scoring systems like the AST to Platelet Ratio Index (APRI) and the Fibrosis Index Based on 4 Factors (FIB-4) have emerged as reliable alternatives to invasive liver biopsy. These tools utilize readily available biomarkers to classify patients based on fibrosis severity, supporting early intervention and reducing the risks associated with traditional diagnostic methods. This review evaluates the diagnostic performance of APRI and FIB-4 in chronic HBV-related liver fibrosis. Studies indicate that while APRI is valued for its simplicity, FIB-4 demonstrates superior sensitivity and specificity, particularly in older populations. Both scores show strong correlations with histological findings and serve as effective tools for diagnosing significant fibrosis and cirrhosis. However, factors such as liver inflammation, comorbidities, and variable fibrosis distribution can influence their accuracy, highlighting the need for careful interpretation. Comparison with advanced methods like FibroScan® underscores the limitations of biochemical indices alone and the importance of combining multiple diagnostic approaches. Future research should focus on longitudinal studies and algorithm optimization to enhance the utility of these non-invasive tools. Integrating APRI and FIB-4 into clinical practice offers a cost-effective and accessible strategy for managing chronic HBV-related liver fibrosis, ultimately improving patient care and outcomes
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Duman, Hakan, Hüseyin Durak, Emrah İpek, Handan Duman, and Müjgan Ayşenur Şahin. "The Relationship Between Liver Fibrosis Scores and Ascending Aortic Dilatation." Journal of Gastrointestinal and Liver Diseases 33, no. 3 (2024): 348–54. http://dx.doi.org/10.15403/jgld-5533.
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Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is related to an increased atherosclerotic cardiovascular disease (ASCVD) risk. This study investigated a potential relationship between liver fibrosis scores (LFS) reflecting NAFLD and ascending aortic dilatation (AAD). Methods: This is an observational and cross-sectional study. Patients were consecutively enrolled from a cardiology clinic. The NAFLD fibrosis score (NFS), fibrosis-4 (FIB-4) index, aspartate aminotransferase (AST) to platelet ratio (APRI), and BARD scores of each patient were calculated. The ascending aortic diameters were evaluated by transthoracic echocardiography according to current clinical guidelines. The patients were allocated into two groups with and without AAD. Results: A total of 272 patients were included in the study. In AAD group, age, patients with hypertension (HT), coronary artery disease (CAD), FIB-4 index, BARD score and the NFS were significantly higher. As compared to the AAD group, body mass index (BMI), hemoglobin, and diuretic use were significantly higher in patients without aortic dilatation. The NFS with AAD, and NFS and FIB-4 index with indexed aortic diameter (AI) showed significant positive correlation (R=0.546, R=0.332, R=0.314 with p<0.001, respectively). In multivariate logistic regression analysis hemoglobin levels (OR=0.728, 95%CI: 0.553-0.958; p=0.023), BMI (OR=0.762, 95%CI: 0.668-0.869, p<0.001), HT (OR=3.269, 95%CI: 1.045-10.220; p=0.042), BARD score (OR=1.248, 95%CIL 0.815-1.955; p=0.044), and FIB-4 index (OR=2.432, 95%CI: 1.395-4.246; p=0.002) were found to be independently related to AAD. Conclusions: Our study demonstrated a statistically significant relationship between NFS, FIB-4 index, BARD score and AAD. The presence of positive correlation among LFS and AAD in our study is remarkable. This may emphasize the increased risk of AAD in NAFLD.
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Rana Ahsan and Mansoor ul Haq. "APRI (AST to Platelet Ration Index) and (Fibrosis-4 Index) Performance to assess liver fibrosis against predefined fibroscan values in chronic Hepatitis C Virus Infection." Professional Medical Journal 32, no. 05 (2025): 545–50. https://doi.org/10.29309/tpmj/2025.32.05.8915.
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Objective: To compare the performance of Fibrosis-4 index (FIB-4), and the AST to platelet ratio index (APRI) versus Fibroscan in chronic hepatitis C virus (CHCV) infection. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi, Pakistan. Period: July 2024 to December 2024. Methods: A total of 250 patients aged 20-70 years, and having CHCV were analyzed. APRI and FIB-4 scores were calculated according. The discriminative ability of APRI, and FIB-4 was evaluated drawing area under the curve (AUC) utilizing receiver operating characteristic (ROC) curve. Based on the optimal cut-off value, the sensitivity and specificity of both scoring systems were computed. Results: For a total of 250 patients, the median scores for APRI, FIB-4, and Fibroscan were 0.63 (0.39-1.05), 2.33 (1.13-3.60), and 9 (5.50-23.92), respectively. Fibrosis stages were noted as 98 (39.2%) F0-F1, 18 (7.2%) F2, 30 (12%) F3, and 104 (41.6%) F4. The AUC indicated that the FIB-4 score was a better predictor of chronic severity than the APRI score (AUC=0.994 vs AUC=0.866) among CHCV patients. The optimal cutoff for the FIB-4 score was 2.440 (sensitivity=92.5%, specificity=100%), 1.550 (sensitivity=100%, specificity=91.4%), and 2.565 (sensitivity=85.1%, specificity=100%). Conclusion: In the context of chronic HCV infection, FIB-4 was better than APRI at differentiating between individuals with and without severe fibrosis and cirrhosis.
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Rasul, Shahla. "ASSESSING THE ACCURACY OF FIB-4 SCORES TO POINT SHEAR WAVE ELASTOGRAPHY IN MONITORING DIFFERENT STAGES OF FIBROSIS IN NON-ALCOHOLIC LIVER DISEASE." JOURNAL OF SULAIMANI MEDICAL COLLEGE 13, no. 3 (2023): 5. http://dx.doi.org/10.17656/jsmc.10420.
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BackgroundNon-alcoholic liver disease (NAFLD) assessment is done by measuring biochemical parameters from blood samples. However, non-invasive methods have gained significance lately. Biochemical parameters and staging of fibrosis-associated NAFLD based on the levels of biomarkers have been established procedures in the field. So, the utilization of non-invasive methods as a comparable means for fibrosis staging in NAFLD has yet to be established.
 ObjectivesTo compare the diagnostic performance of serum markers to point shear wave elastography for classifying fibrosis in NAFLD and its staging.
 Materials and MethodsData were collected by laboratory tests and point shear wave elastography. A comparison of FIB-4 indexes scores and point shear wave elastography for the staging of fibrosis in NAFLD was made based on cross-tabulation of the quantitative data obtained.
 ResultsA positive and significant correlation between FIB4 and age, ALT, AST, RBS, AST/ ALT, AST/ UL AST, APRI, AST/ Platelet count, and point shear wave elastography (PSWE). The correlation was negative and non-significant between FIB4 and Weight, Height, BMI, UL AST, TSB, and Platelet count.
 ConclusionThe study observed a positive correlation between FIB-4 and PSWE. Thus, the present study proposes the use of PSWE as a non-invasive diagnostic tool in the staging of fibrosis in NAFLD for patients with an intermediate FIB-4 score.
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Crisan, Dana, Lucretia Avram, Cristiana Grapa, et al. "Liver Injury and Elevated FIB-4 Define a High-Risk Group in Patients with COVID-19." Journal of Clinical Medicine 11, no. 1 (2021): 153. http://dx.doi.org/10.3390/jcm11010153.
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Liver involvement in Coronavirus Disease 2019 (COVID-19) has been widely documented. However, data regarding liver-related prognosis are scarce and heterogeneous. The current study aims to evaluate the role of abnormal liver tests and incidental elevations of non-invasive fibrosis estimators on the prognosis of hospitalized COVID-19 patients. We conducted a retrospective cohort study to investigate the impact of elevated liver tests, non-invasive fibrosis estimators (the Fibrosis-4 (FIB-4), Forns, APRI scores, and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio), and the presence of computed tomography (CT)-documented liver steatosis on mortality in patients with moderate and severe COVID-19, with no prior liver disease history. A total of 370 consecutive patients were included, of which 289 patients (72.9%) had abnormal liver biochemistry on admission. Non-survivors had significantly higher FIB-4, Forns, APRI scores, and a higher AST/ALT ratio. On multivariate analysis, severe FIB-4 (exceeding 3.25) and elevated AST were independently associated with mortality. Severe FIB-4 had an area under the receiver operating characteristic (AUROC) of 0.73 for predicting survival. The presence of steatosis was not associated with a worse outcome. Patients with abnormal liver biochemistry on arrival might be susceptible to a worse disease outcome. An FIB-4 score above the threshold of 3.25, suggestive of the presence of fibrosis, is associated with higher mortality in hospitalized COVID-19 patients.
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Qadri, Sami, Noora Ahlholm, Ida Lønsmann, et al. "Obesity Modifies the Performance of Fibrosis Biomarkers in Nonalcoholic Fatty Liver Disease." Journal of Clinical Endocrinology & Metabolism 107, no. 5 (2021): e2008-e2020. http://dx.doi.org/10.1210/clinem/dgab933.
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Abstract Context Guidelines recommend blood-based fibrosis biomarkers to identify advanced nonalcoholic fatty liver disease (NAFLD), which is particularly prevalent in patients with obesity. Objective To study whether the degree of obesity affects the performance of liver fibrosis biomarkers in NAFLD. Design Cross-sectional cohort study comparing simple fibrosis scores [Fibrosis-4 Index (FIB-4); NAFLD Fibrosis Score (NFS); aspartate aminotransferase to platelet ratio index; BARD (body mass index, aspartate-to-alanine aminotransferase ratio, diabetes); Hepamet Fibrosis Score (HFS)] and newer scores incorporating neo-epitope biomarkers PRO-C3 (ADAPT, FIBC3) or cytokeratin 18 (MACK-3). Setting Tertiary referral center. Patients We recruited overweight/obese patients from endocrinology (n = 307) and hepatology (n = 71) clinics undergoing a liver biopsy [median body mass index (BMI) 40.3 (interquartile range 36.0-44.7) kg/m2]. Additionally, we studied 859 less obese patients with biopsy-proven NAFLD to derive BMI-adjusted cutoffs for NFS. Main Outcome Measures Biomarker area under the receiver operating characteristic (AUROC), sensitivity, specificity, and predictive values to identify histological stage ≥F3 fibrosis or nonalcoholic steatohepatitis with ≥F2 fibrosis [fibrotic nonalcoholic steatohepatitis (NASH)]. Results The scores with an AUROC ≥0.85 to identify ≥F3 fibrosis were ADAPT, FIB-4, FIBC3, and HFS. For fibrotic NASH, the best predictors were MACK-3 and ADAPT. The specificities of NFS, BARD, and FIBC3 deteriorated as a function of BMI. We derived and validated new cutoffs for NFS to rule in/out ≥F3 fibrosis in groups with BMIs &lt;30.0, 30.0 to 39.9, and ≥40.0 kg/m2. This optimized its performance at all levels of BMI. Sequentially combining FIB-4 with ADAPT or FIBC3 increased specificity to diagnose ≥F3 fibrosis. Conclusions In obese patients, the best-performing fibrosis biomarkers are ADAPT and the inexpensive FIB-4, which are unaffected by BMI. The widely used NFS loses specificity in obese individuals, which may be corrected with BMI-adjusted cutoffs.
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A, Liliana, Noormartany Noormartany, and Sugianli AK. "ANGKA FIB-4 DAN HIGHLY ACTIVE ANTI RETROVIRAL THERAPY DI ANTARA PASIEN PENGIDAP INFEKSI HIV." INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY 20, no. 2 (2018): 80. http://dx.doi.org/10.24293/ijcpml.v20i2.1071.
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Liver disease in patients with HIV infection can be caused by hepatotropical virus co infection or as a side effect of antiretroviraltherapy. The cause of HAART effects on liver fibrosis among patients with HIV infection is not yet known. The monitoring of the incidenceof liver fibrosis can be done with non-invasive markers, such as FIB 4 score. FIB-4 score is calculated by the formula: Age x AST/totalplatelet x √ALT. This is carried out to know the comparison of the FIB-4 score in HIV patients before and after first-line HAART therapy,with or without HCV coinfection. This study was a comparative analysis of retrospective data of patients at the Outpatient Teratai Clinic,Dr. Hasan Sadikin Hospital, from 2003 through 2013. The research subjects consisted of 64 patients with HIV infection who receivedfirst-line HAART therapy for more than 12 months. Statistical analysis was performed by Wilcoxon test for two paired samples. Themedian scores of FIB-4 from HIV infection patients with or without HCV co infection before and after the administration of first-lineHAART therapy were 0.854 and 0.906 (p=0.837). The HCV co infected patients had median scores of FIB-4 before and after treatment at0.854 and 0.899 (p=0.204). Those without HCV co infection had median scores of FIB-4 before and after treatment at 2.726 and 0.912(p=0.013).Treatment with first-line HAART did not lead to a change in the FIB-4 score. Those who were co infected with HCV showed nodifferences in the FIB-4 scores before and after treatment with first-line HAART.
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Gaurav Singh, Kuldeep Chandel, Mandavi Agarwal, Aniket Ashok Satale, and Neha Rathore. "A study to assess hepatic steatosis and fibrosis in chronic hepatitis B patients with the help of non-invasive tests." Asian Journal of Medical Sciences 16, no. 7 (2025): 117–24. https://doi.org/10.71152/ajms.v16i7.4568.
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Background: Chronic hepatitis B (CHB) is a persistent global health issue, frequently leading to hepatic fibrosis and steatosis. Although liver biopsy remains the diagnostic benchmark, its invasiveness necessitates safer alternatives. Non-invasive methods such as FibroScan, aspartate transaminase to platelet ratio index (APRI), and Fibrosis-4 (FIB-4) scores have shown promise in assessing liver pathology. Aims and Objectives: To evaluate the diagnostic performance of APRI, FIB-4, and FibroScan in detecting hepatic fibrosis and steatosis in CHB patients and their correlation with biochemical and virological parameters. Materials and Methods: This cross-sectional study was conducted at Maharani Laxmi Bai Medical College, Jhansi, from January 2023 to June 2024. A total of 112 patients with CHB were enrolled. Liver stiffness and steatosis were assessed using FibroScan and controlled attenuation parameters. APRI and FIB-4 scores were calculated, and laboratory values, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and hepatitis B virus (HBV) DNA, were analyzed. Results: Advanced FIB-4 was observed in 42 patients (37.50%) and severe steatosis (S3) in 41 patients (36.60%). Elevated AST levels (>2×upper limit of normal) were found in 54 patients (48.21%) and ALT in 57 patients (50.89%). High HBV DNA levels (>20,000 IU/mL) were present in 59 patients (52.67%). APRI score >1.5 showed a sensitivity of 85.71% and specificity of 79.55% (area under the curve [AUC]: 0.837), whereas FIB-4 score >3.25 had a sensitivity of 64.29% and specificity of 85.37% (AUC: 0.815). Both scores showed limited utility in detecting steatosis. Conclusion: FibroScan, APRI, and FIB-4 are effective non-invasive tools for assessing hepatic fibrosis in CHB patients. They offer viable alternatives to biopsy, especially in settings with limited resources.
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Tamaki, Nobuharu, Kenta Takaura, Mayu Higuchi, et al. "Enhanced Liver Fibrosis Score for Diagnosing Liver Fibrosis in Chronic Hepatitis." Diagnostics 14, no. 13 (2024): 1317. http://dx.doi.org/10.3390/diagnostics14131317.
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Background and aims: The enhanced liver fibrosis (ELF) score is a blood test that combines three markers linked to liver fibrosis. The utility of the ELF score has been demonstrated primarily in Western countries, but whether it is useful in areas with a high number of elderly people suffering from chronic liver disease has yet to be determined. Methods: This is a prospective study that included 373 consecutive patients who underwent a liver biopsy and had their ELF score measured on the same day. The diagnostic accuracy of the ELF score for liver fibrosis and the effect of age on the ELF score were investigated. Results: The median (interquartile) ELF scores in F0, F1, F2, F3, and F4 are 8.7 (8.2–9.2), 9.3 (8.8–10.0), 10.1 (9.4–10.7), 10.7 (9.9–11.2), and 12.0 (11.2–12.7), respectively. ELF scores increased with increasing liver fibrosis stage (p < 0.001). The diagnostic accuracy of the ELF score and FIB-4 for significant fibrosis (F2–4) and advanced fibrosis (F3–4) was comparable, but the ELF score had a higher diagnostic accuracy for cirrhosis (F4) than FIB-4. When patients were stratified by age of 60 years, the median ELF score did not differ by age in F2, F3, and F4. However, the median FIB-4 increased in patients with ≥60 years compared to those with <60 years in all fibrosis stages. Conclusions: ELF score has high diagnostic accuracy for liver fibrosis, regardless of age, and it could be used as a primary screening method.
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Charoenchue, Puwitch, Jiraporn Khorana, Apichat Tantraworasin, et al. "Simple Clinical Prediction Rules for Identifying Significant Liver Fibrosis: Evaluation of Established Scores and Development of the Aspartate Aminotransferase-Thrombocytopenia-Albumin (ATA) Score." Diagnostics 15, no. 9 (2025): 1119. https://doi.org/10.3390/diagnostics15091119.
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Background: Existing non-invasive tests (NITs) for liver fibrosis offer moderate precision and accessibility but are often limited by complexity, reducing their practicality in routine clinical use. This study aimed to evaluate the diagnostic performance of current fibrosis assessment methods and develop a novel, simplified scoring system—the Aspartate Aminotransferase (AST)-Thrombocytopenia-Albumin (ATA) score—to enhance ease of use and clinical applicability. Methods: This study examined past cases of patients with chronic liver disease (CLD) by using magnetic resonance elastography (MRE) to evaluate fibrosis stages. Serum biomarkers were collected, and common fibrosis scores were calculated. Logistic regression identified potential predictors of significant fibrosis, forming the ATA score. Diagnostic performance was assessed, and internal validation was conducted via bootstrap resampling. Results: Among 70 patients, 31.4% had significant fibrosis. Hepatitis B was the most common cause (60.0%), followed by hepatitis C (18.6%) and nonalcoholic fatty liver disease (NAFLD, 15.7%). The ATA score demonstrated an area under the receiver operating characteristic curve (AUROC) of 0.872, comparable to the AST-to-platelet ratio index (APRI; 0.858) and fibrosis-4 index (FIB-4; 0.847). The recommended cut-offs for identifying high-risk patients were ATA score ≥ 2 (specificity 95.8%, sensitivity 50.0%), APRI ≥ 0.50 (specificity 89.6%, sensitivity 68.2%), and FIB-4 ≥ 1.3 (specificity 58.3%, sensitivity 90.9%). Internal validation confirmed model robustness, with an optimism-corrected AUROC of 0.8551. Conclusions: The ATA score offers a straightforward and efficient method for detecting significant fibrosis, demonstrating comparable diagnostic capability to APRI and FIB-4, while being more user-friendly in clinical practice. A score of 0–1 indicates low risk, suitable for clinical follow-up, whereas a score of ≥2 suggests high risk, warranting further evaluation. Integrating the ATA score into clinical workflows can enhance early detection, optimize resource utilization, and improve patient care.
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Sindhughosa, D. A., I. K. Mariadi, I. D. N. Wibawa, et al. "Evaluation of Mortality Risk in Liver Cirrhosis with Albumin- Bilirubin (Albi), Platelet-Albumin-Bilirubin (Palbi), and Fibrosis-4 (Fib-4) Scores." Biomedical and Pharmacology Journal 14, no. 02 (2021): 985–91. http://dx.doi.org/10.13005/bpj/2200.
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Background:The model for end stage liver disease (MELD) score considered as a reliable predictor of survival for advanced liver diseases patients. Among several chemistry laboratorium examinations, albumin, bilirubin and platelet reflect the function of the liver. Objectives: To investigate the correlation of albumin-bilirubin (ALBI), platelet-albumin-bilirubin (PALBI), and fibrosis-4 (FIB-4) scores with mortality risk based on MELD score and evaluate their role in predictingcirrhosis mortality risk. Methods: The analytic cross-sectional study designrecruited adults with liver cirrhosis of any etiology during the period of November 2018 through January 2019. Descriptive and correlative analyses were done before proceeding to diagnostic abilityanalysis. Results: Sixty-two patients with mean age of 52.95 ± 12.05 were included in the analysis. The ALBI, PALBI, and FIB-4 scores were significantly correlated with higher mortality risk based on MELD score. The three scoressignificantly predicted higher mortality risk with varying sensitivity and specificity. Conclusion: Positivecorrelation between ALBI, PALBI, and FIB-4 scores with MELD score was found. ALBI (≥-1.26), PALBI (≥-2.05), and FIB-4 (≥5.84) values higher than the thresholdcould predict mortality risk in cirrhosis.
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Debnath, P., S. Nair, P. Rathi, et al. "Serum biomarkers as an alternative to vibration controlled transient elastography in liver fibrosis staging in chronic hepatitis C." Acta Gastro Enterologica Belgica 84, no. 1 (2021): 43–50. http://dx.doi.org/10.51821/84.1.776.
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Background : Assessment of liver disease severity in chronic Hepatitis C (CHC) is essential both in pre-treatment and post-treatment period. We assessed the impact of direct-acting antiviral therapy on liver stiffness regression measured by Vibration Controlled Transient Elastography (VCTE) in patients with CHC and evaluated the diagnostic performance of the APRI and FIB-4 scores compared to VCTE in detecting advanced fibrosis and cirrhosis (F3/F4). Methodology : Retrospective analysis of consecutive patients with CHC who underwent VCTE before and after DAA therapy was done. APRI and FIB-4 scores were compared to VCTE. Results : 88 (56.78%) patients-12 (F3) and 76 (F4) according to VCTE, had advanced fibrosis pre-treatment, which reduced to 69 (44.52%) - 10 (F3) and 59 (F4) after 12 weeks DAA therapy. Significant reduction in VCTE value from 14.08 ± 9.05 KPa to 11.84 ± 8.31 KPa (p=0.002) was noted. There is significant reduction in APRI, FIB-4 and GUCI score post-treatment which was not the case with Lok score and Bonacini score. Before therapy, FIB-4 outperformed others to predict advanced fibrosis with score >2.13 (AUC 0.93), having sensitivity 76%, specificity 96% and accuracy 86%. However post-treatment, APRI and GUCI score performed best to predict F3/F4 fibrosis with score >0.63 (AUC 0.97) and >0.64 (AUC 0.96), having sensitivity, specificity and accuracy of 85%, 96.6% and 92% ; 85%, 96.6% and 92% respectively. Conclusion : Before therapy, FIB-4 had the best accuracy in predicting advanced fibrosis whereas APRI and GUCI score were the best indices post-treatment.
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Calapod, Ovidiu P., Andreea M. Marin, Minodora Onisai, Laura C. Tribus, Corina S. Pop, and Carmen Fierbinteanu-Braticevici. "The Impact of Increased Fib-4 Score in Patients with Type II Diabetes Mellitus on COVID-19 Disease Prognosis." Medicina 57, no. 5 (2021): 434. http://dx.doi.org/10.3390/medicina57050434.
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Background: Emerging evidence suggests that patients with metabolic (dysfunction) associated fatty liver disease (MAFLD) are prone to severe forms of coronavirus disease (COVID-19), especially those with underlying liver fibrosis. The aim of our study is to assess the association of an increased FIB-4 score with COVID-19 disease prognosis. Methods: We performed a prospective study on hospitalized patients with known type II diabetes mellitus (T2DM) and confirmed COVID-19, with imaging evidence of liver steatosis within the last year or known diagnosis of MAFLD. All individuals were screened for liver fibrosis with a FIB-4 index. We evaluated the link between FIB-4 and disease prognosis. Results: Of 138 participants, 91.3% had MAFLD and 21.5% patients had a high risk of fibrosis. In the latter group of patients, the number of severe forms of disease, the hospital stay length, the rate of ICU admissions and the number of deaths reported registered a statistically significant increase. The independent predictors for developing severe forms of COVID-19 were obesity (odds ratio (OR), 3.24; 95% confidence interval (CI), p = 0.003), higher values of ferritin (OR-1.9; 95% CI, 1.17–8.29, p = 0.031) and of FIB-4 ≥ 3.25 (OR-4.89; 95% CI, 1.34–12.3, p = 0.02). Conclusions: Patients with high scores of FIB-4 have poor clinical outcomes and liver fibrosis may have a relevant prognostic role. Although the link between liver fibrosis and the prognosis of COVD-19 needs to be evaluated in further studies, screening for liver fibrosis with FIB-4 index, particularly in patients at risk, such as those with T2DM, will make a huge contribution to patient risk stratification.
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Abbas, Syed Hamza, Elisha Pickett, David A. Lomas, et al. "Non-invasive testing for liver pathology in alpha-1 antitrypsin deficiency." BMJ Open Respiratory Research 7, no. 1 (2020): e000820. http://dx.doi.org/10.1136/bmjresp-2020-000820.
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BackgroundMany patients with alpha-1 antitrypsin deficiency (A1ATD) receive care in respiratory clinics without access to specialist hepatology expertise. Liver disease can develop asymptomatically, and non-invasive markers of fibrosis may help identify patients who require definitive assessment with liver biopsy. We evaluated the utility of non-invasive markers of liver fibrosis in A1ATD to guide testing in settings without ready access to hepatology expertise.MethodsPatients attending the London A1ATD service undergo assessment using blood tests to calculate the ‘APRI’ and ‘FIB-4’ score, liver ultrasound and Fibroscan. Liver biopsy is offered to patients who have abnormal liver function tests with abnormal liver ultrasound and/or liver stiffness >6 kPa on Fibroscan. Liver biopsies were assessed for the presence of A1AT, steatosis, fibrosis and inflammation.Results75 patients with A1ATD had results for analysis, 56% were female, age 16–82 years. 75% of patients had Fibroscan <6 kPa, 19% had Fibroscan 6–7.9 kPa and 6%>8 kPa. There was a significant correlation between FIB-4 and Fibroscan (r=0.244, p=0.035). Fibroscan >6 kPa corresponded to a FIB-4 score of >1.26. However, FIB-4 >1.26 had poor sensitivity (47%), specificity (32%) and positive-predictive value (PPV; 36%) to identify Fibroscan >6 kPa. The negative-predictive value (NPV) was stronger at 81%. APRI data were similar. Twelve patients underwent liver biopsy, with 11 reports available for analysis. Six had FIB-4 scores<1.26 and five had Fibroscan of <6 kPa. A1AT was present in 64% of biopsies, steatosis in 82%, mild fibrosis in 36%, moderate fibrosis in 9% and severe fibrosis in 9%.ConclusionA combination of liver ultrasound and non-invasive fibrosis tests can help identify patients with A1ATD liver injury. However, APRI and FIB-4 scores alone had poor sensitivity and specificity to justify use as an independent tool for liver pathology in A1ATD.
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Salahshour, Faeze, Sahar Karimpour Reyhan, Kazem Zendedel, et al. "FIB-4 Index Can Predict Mortality in Hospitalized Patients with COVID-19 Infection, Independent of CT Severity Score." Archives of Iranian Medicine 28, no. 2 (2025): 88–94. https://doi.org/10.34172/aim.33514.
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Background: The fibrosis 4 (FIB-4) index is typically used in assessing liver fibrosis, and has shown potential in predicting the outcome in various diseases. This study aims to evaluate the predictive power of the FIB-4 index for mortality in COVID-19 patients admitted to a reference hospital in Tehran, Iran. Methods: In this prospective cohort study, 387 patients with COVID-19 without diabetes, were categorized into deceased and surviving groups. We compared anthropometric and demographic data, liver function tests, CT scores, and FIB-4 indices between the groups. Multivariate logistic regression assessed the independent association of FIB-4 with mortality. Results: Among the 387 patients, (all non-diabetics), 58 (15%) died, with a higher mortality rate observed in patients with a FIB-4 index≥2.6 (63.4%) compared to those with FIB-4<2.6 (29.7%). Deceased patients were considerably older and more likely to be hypertensive (P values<0.001). After adjustment of confounding factors, a FIB-4 index≥2.6 was found to be independently associated with increased mortality (OR: 13.511, 95% CI: 1.356-134.580, P=0.026). Conclusion: The FIB-4 index, calculable by routine laboratory tests, may be a valuable prognostic factor for COVID-19 mortality. This easily obtainable marker could help identify high-risk patients early, potentially allowing for more rapid intervention and treatment prioritization.
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Lima, Rodrigo Vieira Costa, José Tadeu Stefano, Fernanda de Mello Malta, et al. "Ability of a Combined FIB4/miRNA181a Score to Predict Significant Liver Fibrosis in NAFLD Patients." Biomedicines 9, no. 12 (2021): 1751. http://dx.doi.org/10.3390/biomedicines9121751.
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Liver biopsy is the gold standard for assessing fibrosis, but there is a need to seek non-invasive biomarkers for this purpose. The aim of this study was to evaluate the correlation between the serum levels of the microRNAs miR-21, miR-29a, miR-122, miR-155 and miR-181a and the phenotypic expression of NAFLD. A cross-sectional study was carried out on 108 NAFLD patients diagnosed by liver biopsy. FIB-4 and NAFLD fibrosis scores were calculated. The comparison between the distributions of microRNA values according to the presence or absence of histological fibrosis (F2–F4) was performed. A multivariate logistic regression analysis was performed to build a score for predicting fibrosis using FIB-4 and Ln (miR-181a) as independent variables. Only miR-181a showed a statistical difference between patients with significant liver fibrosis (>F2) and those without (F0–F1) (p = 0.017). FIB-4 revealed an AUC on the ROC curve of 0.667 to predict clinically significant fibrosis (F2–F4). When assessed using the score in association with Ln (miR-181a), there was an improvement in the ROC curve, with an AUC of 0.71. miR-181a can be used as a non-invasive method of predicting fibrosis in NAFLD, and an association with FIB-4 has the potential to increase the accuracy of each method alone.
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Cho, Eun Ju, Su Jong Yu, Yun Bin Lee, Jeong-Hoon Lee, Yoon Jun Kim, and Jung-Hwan Yoon. "Prognostic Values of Inflammation-Based Scores and Fibrosis Markers in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization." Diagnostics 12, no. 5 (2022): 1170. http://dx.doi.org/10.3390/diagnostics12051170.
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Background: Inflammation is a key feature shaping the microenvironment of hepatocellular carcinoma (HCC), and liver fibrosis is associated with the prognosis of patients with HCC. In this study, we investigated whether baseline inflammation-based scores and serum fibrosis markers can help in predicting the prognosis of HCC patients treated with transarterial chemoembolization (TACE). Methods: A total of 605 consecutive patients with HCC treated by TACE were included. The systemic immune-inflammation index (SII), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), FIB-4 index, and aspartate aminotransferase-to-platelet ratio index (APRI) were analyzed regarding their associations with disease progression and survival. Results: All tested inflammation-based scores and fibrosis markers were significantly associated with tumor progression and overall survival in the univariate analyses. In the multivariate analysis, NLR (hazard ratio [HR], 1.06; p = 0.007) and FIB-4 (HR = 1.02, p = 0.008) were independent risk factors for disease progression, along with α-fetoprotein (AFP) levels, maximum tumor size and number, and presence of vascular invasion. Furthermore, NLR (HR, 1.09; p < 0.001) and FIB-4 (HR, 1.02; p = 0.02) were independent prognostic factors for survival. Conclusions: High baseline NLR and FIB-4 levels might help the prediction of disease progression and death in patients with HCC after TACE.
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Pi, S., R. A. Mitchell, A. Mohajerani, J. Farivar, H. Ko, and A. Ramji. "A136 PREDICTIVE FACTORS OF CIRRHOSIS IN HCV PATIENTS WITH LOW PRE-TREATMENT APRI AND/OR FIB-4 SCORES." Journal of the Canadian Association of Gastroenterology 3, Supplement_1 (2020): 157–58. http://dx.doi.org/10.1093/jcag/gwz047.135.
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Abstract Background It is essential to evaluate the stage of hepatic fibrosis prior to the initiation of HCV therapy. In addition to being a major prognostic factor, the presence of cirrhosis requires monitoring for hepatocellular carcinoma (HCC), esophageal varices, and decompensated liver disease. In some cases the presence of cirrhosis may affect the choice of therapy. In tertiary hepatology clinics, transient elastography (TE) is routinely used to assess fibrosis; however access to TE is limited. Fibrosis-4 (FIB4) and AST-to-platelet ratio index (APRI) are simple, easily available non-invasive methods of fibrosis measurement based on routine serum biomarkers. Studies evaluating HCV treatment pathways have reported that the use of FIB4 and APRI are cost-effective strategies for excluding cirrhosis thereby reducing the need for TE prior to treatment. Although the NPV of these tests are well described, a minority of patients will have advanced fibrosis despite low APRI and/or FIB4 scores. Aims To investigate predictive factors of cirrhosis in HCV patients with low pre-treatment APRI and/or FIB-4 scores. Methods Retrospective observational study with data obtained from the Pacific Gastroenterology Associates (PGA), a tertiary care outpatient Gastroenterology clinic located in Vancouver, British Columbia. Inclusions: Chronic HCV patients treated between Jan 2015 to 2019, pre-treatment TE values ≥12.5 kPa, FIB-4 &lt;1.45 and/or APRI &lt;0.7. Exclusions: those without cirrhosis, or incomplete evaluation prior to HCV treatment. Cirrhosis was defined as those with TE ≥12.5 kPa with clinical, radiographic, or pathologic features of cirrhosis. Results 52 patients were identified. 11 patients did not have clinical, radiographic, or pathologic features of cirrhosis and 3 patients were excluded for insufficient data. Thus, 39 patients were included in multivariate analysis. The mean age was 59 years and 66% (25/38) were male gender. 10% (4/38) were Genotype 3 (G3). Presence of G3 was not included in the multivariate analysis due to low number of observations. Conclusions Generally, an APRI &lt;0.7 and FIB-4 &lt;1.45 have good test characteristics for excluding fibrosis. Our study demonstrates that patients with obesity, dyslipidemia, excessive alcohol use, or known steatosis on ultrasound may have cirrhosis despite low serum biomarker scores. Co-existence of other liver diseases such as alcohol related or non-alcoholic fatty liver disease (NAFLD) should prompt further evaluation for fibrosis assessment beyond biomarkers as these persons may have more advanced liver disease. Funding Agencies None
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Kakar, Fahad, Arif Rasheed Siddiqui, Saad Khalid Niaz, et al. "Comparison of Fibrosis-4 with FibroScan for Liver Fibrosis Assessment in Non-Alcoholic Fatty Liver Disease Patients: A Cross-sectional Study." Journal of the Dow University of Health Sciences 18, no. 2 (2024): 79–83. http://dx.doi.org/10.36570/jduhs.2024.2.2167.
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Objective: To compare the efficacy and accuracy of the Fibrosis-4 (FIB-4) index with FibroScan in assessing liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). Methods: This cross-sectional study was conducted at Patel Hospital, Karachi, Pakistan, from October 2023 to April 2024. All known cases of NAFLD or non-alcoholic steatohepatitis (NASH) aged ≥18 years, regardless of gender, were included. FIB-4 scores were measured using age, platelet level, aspartate transaminase (AST), and alanine transaminase (ALT). FibroScan categorized liver fibrosis into stages F0 to F4 with specific stiffness ranges: F0 (1–6 kPa), F1 (6.1–7 kPa), F2 (7.1–9 kPa), F3 (9.1–10.3 kPa), and F4 (≥10.4 kPa). Results: Of the 146 patients, the median age was 52.00 (IQR: 47.00–54.00) years. Based on FibroScan results, 61 (41.8%) patients were classified as F1, 35 (24.0%) as F2, 30 (20.5%) as F3, and 20 (13.7%) as F4. The diagnostic performance of FIB-4 showed an area under the curve of 0.83 (95% CI: 0.76–0.90). The optimal cut-off for FIB-4 was 1.28 with sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy of 98.0%, 65.6%, 59.7%, 98.4%, and 76.7%, respectively. Spearman's correlation test (ρ) was applied and a significantly moderate correlation was found between FibroScan and FIB-4 (ρ = 0.50, p < 0.001). Conclusion: FIB-4 demonstrated higher accuracy and diagnostic performance in determining liver fibrosis in NAFLD patients compared to FibroScan.
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Patel, Arti, Soheil Saadat, and Adewale B. Ajumobi. "Sa1556: ROLE OF FIBROSIS-4 INDEX (FIB-4) SCORES IN SCREENING FOR ADVANCED FIBROSIS IN PATIENTS WITH DIABETES MELLITUS." Gastroenterology 169, no. 1 (2025): S—1698. https://doi.org/10.1016/s0016-5085(25)04776-6.
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Rana Ahsan and Mansoor ul Haq. "Comparison of APRI, FIB-4 and fibroscan for detecting chronic liver disease severity among chronic Hepatitis B Patients in Pakistan." Professional Medical Journal 32, no. 04 (2025): 411–16. https://doi.org/10.29309/tpmj/2025.32.04.8912.
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Objective: To compare aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 index (FIB-4), and fibroscan scores in evaluating severity of chronic liver disease (CLD) in chronic hepatitis B (CHB) patients. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi, Pakistan. Period: 11th July 2024 to 10th January 2025. Methods: A total of 250 patients aged 18 years or above, and presenting with CHB were analyzed. Necessary laboratory investigations and Fibroscan evaluation were performed for the assessment of APRI and FIB-4 scores and fibrosis confirmation. Predictive ability of all scores was determined by plotting receiver operating characteristic curve (ROC), and determining area under the curve (AUC). Youden index was applied for the calculation of the optimal cut-off value of the score. Results: Total 22.0% were female and 78.0% were male patients. Median (IQR) scores for APRI, FIB-4, and Fibroscan were 0.74 (0.35-2.20), 1.32 (0.90-2.90), and 9.10 (5.30-16.00). The AUC indicates that the APRI score (AUC=0.980) is a better predictor of CLD severity than the FIB-4 score (AUC=0.929). The optimal cutoff for APRI score was 0.789 (sensitivity=85.3%, specificity=100%), 0.662 (sensitivity=92.2%, specificity=92.6%), and 0.858 (sensitivity=78.3%, specificity=100%). Conclusion: In CHB patients, APRI seems an excellent tool for determining the severity of CLD and showed the highest association with FibroScan results.
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Yılmaz, Gülçin, İdris Kurt, Ali Rıza Soylu, Ufuk Usta, Derya Karabulut, and Burak Uslu. "The contribution of imaging to non-invasive fibrosis biomarkers in the diagnosis and staging of chronic liver disease." Kastamonu Medical Journal 4, no. 1 (2024): 15–18. http://dx.doi.org/10.51271/kmj-0134.
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Aims: Gold standard technique for determining the stage of fibrosis in cirrhosis is a biopsy. Non-invasive tests are used when a biopsy is contraindicated. However, their specificity and sensitivity still fall short of expectations. Aim of the study is to develop a model capable of determining fibrosis using serum biomarkers and liver ultrasonography. Methods: A retrospective study was designed including patients with chronic hepatitis B and C underwenting liver biopsies between the time frame of 2015 to 2020 years at Trakya University School of Medicine. Epidemilogical data, ltrasonography and pathology reports were noted. Blood values were recorded and used to calculate AST / Platelet Ratio Index (APRI), Fibrosis-4 Index (FIB-4), Gothenburg University Cirrhosis Index (GUCI) noninvasive fibrosis indices. The fibrosis stages of the patients were assessed accoridng to pathology reports into three categories: advanced (F5-F6), moderate (F3-F4), and lower Ishak scores. Results: A total of 259 patients were included in the study. The median age of the patients was 54 (19-90), and 40.9% (106) were female. The median values of APRI, GUCI and FIB-4 scores were respectively: 0.6 (0-21.8), 0.6 (0-26.2) and 1.6 (0.2-8.5). The effects of ultrasonography findings were examined to improve the diagnostic performance of APRI, GUCI and FIB-4 indices. Accompanied by statistical analysis, it was observed that the FIB-4 index and the presence of hepatosteatosis in the liver had a significant effect on the detection of F?3 (respectively; p<0.001, p=0.033). A new model named FIB4u (ultrasonography) was developed. The AUC values of indices for differentiation of intermediate and advanced stages of fibrosis (?3) were respectively:FIB4u 0.760; FIB-4 0.753; GUCI 0.676; APRI 0.667 (p<0.001). The FIB4u index demonstrated considerably better performance compared to both APRI and GUCI. Conclusion: The FIB4u index, developed by combining ultrasonography and laboratory data, can be used as a new index for fibrosis assessment in the absence of advanced elastography techniques. It needs to be validated in larger patient cohorts to be used safely in the long term.
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Masnadi Shirazi, Kourosh, Elham Shirinpour, Arman Masnadi Shirazi, and Zeinab Nikniaz. "Does Cranberry Supplementation Decrease Noninvasive Fibrosis Scores in NAFLD Patients? A Randomized Clinical Trial." International Journal of Drug Research in Clinics 1 (January 1, 2023): e15. http://dx.doi.org/10.34172/ijdrc.2023.e15.
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Background: Due to the lack of effective treatment for non-alcoholic fatty liver disease (NAFLD), we assumed that cranberry supplementation may be effective in these patients. Therefore, we investigated the effect of cranberry supplementation on fibrosis levels in patients with NAFLD. Methods: This trial was designed as a randomized controlled clinical trial. It included 110 adult patients (aged>18 years) with NAFLD. All patients were visited by an expert dietitian and received the hypocaloric diet plus vitamin E supplement. Then, the patients entered into a six-month trial to receive cranberry capsules (55 patients) or placebo (55 patients). We calculated the NAFLD fibrosis score (NFS), fibrosis scores based on 4 factors (FIB-4), and aspartate aminotransferase (AST) to platelet ratio index (APRI). The intention-to-treat (ITT) approach was used to analyze the data. Results: The participants’ mean age was 43.16±10.23 years. The demographic and baseline clinical features were similar in the two groups. In the cranberry group, there were significant changes in APRI (P=0.03), and NFS (P<0.001) scores. In the placebo groups, there were significant changes in APRI (P=0.005), FIB-4 (P=0.03), and NFS (P<0.001) scores. However, no between-group significant differences were observed in the changes in FIB-4 (P=0.64), APRI (P=0.78), and NFS score (P=0.38). Conclusion: Based on the results, cranberry supplementation was not more effective than placebo in liver fibrosis grade.
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Wadhva, Rajesh Kumar, Muhammad Manzoorul Haque, Nasir Hassan Luck, Abbas Ali Tasneem, Zaigham Abbas, and Muhammad Mubarak. "Diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis 4 scores in predicting advanced liver fibrosis in patients with end-stage renal disease and chronic viral hepatitis: Experience from Pakistan." Journal of Translational Internal Medicine 6, no. 1 (2018): 38–42. http://dx.doi.org/10.2478/jtim-2018-0008.
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Abstract Objectives The aim was to assess the diagnostic accuracy of APRI and FIB-4 in assessing the stage of liver fibrosis in end stage renal disease (ESRD) patients with chronic viral hepatitis and to compare the two tests with standard tru-cut liver biopsy. Material and Methods The study was conducted at Sindh Institute of Urology and Transplantation Karachi (SIUT) from May 2010 to May 2014. All ESRD patients, being considered as candidates for renal transplantation and in whom liver biopsy was performed were included. Fibrosis stage was assessed on liver biopsy using Ishak scoring system. The serum transaminases and platelet counts were used to calculate APRI and FIB-4 scores. Results Out of 109 patients, hepatitis C and B virus infections were present in 104 (95.4%) and 3(2.8%), respectively, while 2 (1.8%) patients had both infections. The mean Ishak fibrosis score was 1.95 ± 2. Advanced fibrosis was noted in 37 (34%) patients. Univariate analysis showed that advanced liver fibrosis was associated with lower platelets counts (P=0.001) and higher aspartate aminotransferase (AST) (P=0.001), alanine aminotransferase (ALT) (P=0.022), APRI score (P=0.001) and FIB-4 score (P=0.001). On logistic regression analysis, only APRI score (P < 0.001) was found to be the independent variable associated with advanced liver fibrosis. APRI score cutoff ≥1 indicating advanced fibrosis showed sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 91.9%, 90.3%, 82.9%, 95.6%, respectively with area under the curve (AUC) of 0.97. Similarly, a FIB-4 score cutoff ≥1.1 had sensitivity, specificity, PPV and NPV of 70.27%, 66.67%, 52% and 81.36%, respectively with AUC of 0.74. Conclusion APRI is more accurate noninvasive test for assessing advanced liver fibrosis in ESRD patients as compared to FIB-4. It can be used to obviate the need for liver biopsy in this high risk population.
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Mikolasevic, Ivana, Viktor Domislovic, Irena Krznaric-Zrnic, et al. "The Accuracy of Serum Biomarkers in the Diagnosis of Steatosis, Fibrosis, and Inflammation in Patients with Nonalcoholic Fatty Liver Disease in Comparison to a Liver Biopsy." Medicina 58, no. 2 (2022): 252. http://dx.doi.org/10.3390/medicina58020252.
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Background and Objective: This study was conducted to evaluate the diagnostic performance of various biomarkers for steatosis, fibrosis, and inflammation in comparison to a liver biopsy (LB) in patients with nonalcoholic fatty liver disease (NAFLD). Materials and Methods: This was a cross-sectional study that included 135 patients with biopsy-proven NAFLD. Fatty liver index (FLI), hepatic steatosis index (HSI), cell death markers (CK-18 M30 and CK-18 M65), FIB-4 index, NAFLD fibrosis score (NFS), BARD, and AST to platelet ratio index (APRI) were calculated and analysed. Results: FLI, HSI scores, and the cell death biomarkers showed poor diagnostic accuracy for steatosis detection and quantification, with an area under the curve (AUC) of <0.70. The cell death biomarkers likewise did not perform well for the detection of nonalcoholic steatohepatitis (NASH) (AUC < 0.7). As for the fibrosis staging, only APRI and the cell death biomarkers had moderate accuracy (AUC > 0.7) for advanced fibrosis, whereas FIB-4, BARD, and NFS scores demonstrated poor performance (AUC < 0.70). However, a combination of FIB-4 and NFS with the cell death biomarkers had moderate accuracy for advanced (≥F3) fibrosis detection, with an AUC of >0.70. Conclusions: In this first study on Croatian patients with NAFLD, serum biomarkers demonstrated poor diagnostic performance for the noninvasive diagnosis of liver steatosis and NASH. APRI and the cell death biomarkers had only moderate accuracy for diagnosing advanced fibrosis, as did the combination of FIB-4 and NFS with the cell death biomarkers. Further studies regarding serum biomarkers for all NAFLD stages are needed.
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Fandler-Höfler, Simon, Rudolf E. Stauber, Markus Kneihsl, et al. "Non-invasive markers of liver fibrosis and outcome in large vessel occlusion stroke." Therapeutic Advances in Neurological Disorders 14 (January 2021): 175628642110372. http://dx.doi.org/10.1177/17562864211037239.
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Background: Liver fibrosis has been identified as an outcome predictor in cardiovascular disease and has been associated with hematoma expansion and mortality in patients with primary intracerebral hemorrhage. We aimed to explore whether clinically inapparent liver fibrosis is related to neurological outcome, mortality, and intracranial hemorrhage risk in ischemic stroke patients after mechanical thrombectomy. Methods: We included consecutive patients with anterior circulation large vessel occlusion stroke treated at our center with mechanical thrombectomy between January 2011 and April 2019. Clinical data had been collected prospectively; laboratory data were extracted from our electronic hospital information system. We calculated the Fibrosis-4 index (FIB-4), an established non-invasive liver fibrosis test. The main outcomes were postinterventional intracranial hemorrhage, unfavorable functional status (modified Rankin scale scores of 3–6), and mortality three months post-stroke. Results: In the 460 patients (mean age 69 years, 49.3% female) analyzed, FIB-4 indicated advanced liver fibrosis in 22.6%. Positive FIB-4 was associated with unfavorable neurological outcomes and mortality three months post-stroke, even after correction for co-factors [Odds Ratio (OR) 2.15 for unfavorable outcome in patients with positive FIB-4, 95% confidence interval (CI) 1.21–3.83, p = 0.009, and 2.16 for mortality, 95% CI 1.16–4.03, p = 0.01]. However, FIB-4 was neither related to hemorrhagic transformation nor symptomatic intracranial hemorrhage. Moreover, atrial fibrillation was more frequent in patients with liver fibrosis ( p < 0.001). Two further commonly-used liver fibrosis indices (Forns index and the Easy Liver Fibrosis Test) yielded comparable results regarding outcome and atrial fibrillation. Conclusions: Clinically inapparent liver fibrosis (based on simple clinical and laboratory parameters) represents an independent risk factor for unfavorable outcomes, including mortality, at three months after stroke thrombectomy. Elevated liver fibrosis indices warrant further hepatological work-up and thorough screening for atrial fibrillation in stroke patients.
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Schreiner, Andrew D., Jingwen Zhang, William P. Moran, et al. "FIB-4 as a Time-varying Covariate and Its Association With Severe Liver Disease in Primary Care." Journal of Clinical Gastroenterology, November 16, 2023. http://dx.doi.org/10.1097/mcg.0000000000001935.
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Background and Goals: The Fibrosis-4 Index (FIB-4) has demonstrated a strong association with severe liver disease (SLD) outcomes in primary care, but previous studies have only evaluated this relationship using 1 or 2 FIB-4 scores. In this study, we determined the association of FIB-4 as a time-varying covariate with SLD risk using time-dependent Cox regression models. Study: This retrospective cohort study included primary care patients with at least 2 FIB-4 scores between 2012 and 2021. The outcome was the occurrence of an SLD event, a composite of cirrhosis, complications of cirrhosis, hepatocellular carcinoma, and liver transplantation. The primary predictor was FIB-4 advanced fibrosis risk, categorized as low-(<1.3), indeterminate-(1.3≤FIB to 4<2.67), and high-risk (≥2.67). FIB-4 scores were calculated and the index, last, and maximum FIB-4s were identified. Time-dependent Cox regression models were used to estimate hazard ratios (HR) and their corresponding 95% CI with adjustment for potentially confounding covariates. Results: In the cohort, 20,828 patients had a median of 5 (IQR: 3 to 11) FIB-4 scores each and 3% (n=667) suffered an SLD outcome during follow-up. Maximum FIB-4 scores were indeterminate-risk for 34% (7149) and high-risk for 24% (4971) of the sample, and 32% (6692) of patients had an increase in fibrosis risk category compared with their index value. The adjusted Cox regression model demonstrated an association between indeterminate- (hazard ratio 3.21; 95% CI 2.33-4.42) and high-risk (hazard ratio 20.36; 95% CI 15.03-27.57) FIB-4 scores with SLD outcomes. Conclusions: Multiple FIB-4 values per patient are accessible in primary care, FIB-4 fibrosis risk assessments change over time, and high-risk FIB-4 scores (≥2.67) are strongly associated with severe liver disease outcomes when accounting for FIB-4 as a time-varying variable.
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Yang, Rongrong, Xien Gui, Hengning Ke, Yong Xiong, and Shicheng Gao. "Combination antiretroviral therapy is associated with reduction in liver fibrosis scores in patients with HIV and HBV co-infection." AIDS Research and Therapy 18, no. 1 (2021). http://dx.doi.org/10.1186/s12981-021-00419-y.
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Abstract Background Liver fibrosis is common in individuals with HIV/HBV co-infection, but whether cART could reverses liver fibrosis is unclear. Methods This was a retrospective observational study. Binary logistic regression was used to assess predictors of liver fibrosis in individuals with HIV/HBV co-infection. Comparison of FIB-4 scores before and after cART were compared using X2 test and t test. Results Four hundred and fifty-eight individuals with HIV/HBV co-infection were included in this study. It was found that cART (HR 0.016, 95% CI: 0.009–0.136; P < 0.001) was one of protection factors to against liver fibrosis. Forty individuals who had normal levels of ALT, AST and PLT during the whole course of diseases were stratified into FIB-4 < 1.45 (n = 14), 1.45 ≤ FIB-4 ≤ 3.25 (n = 19) and FIB-4 > 3.25 (n = 7) groups by their FIB-4 scores before cART. In 1.45 ≤ FIB-4 ≤ 3.25 group, 57.9%(11/19) of the individuals dropped to FIB-4 < 1.45 group by cART; in FIB-4 > 3.25 group, 85.7%(6/79) dropped to 1.45 ≤ FIB-4 ≤ 3.25 group, while 14.3%(1/7) dropped to FIB-4 < 1.45 group. In cART-naive group, 1 year, 2–5 years and 5–10 years post-cART groups, FIB-4 scores were 4.29 ± 0.43, 3.63 ± 0.38, 2.90 ± 0.36 and 2.52 ± 0.38, respectively (P = 0.034); and the incidence of liver fibrosis were 7.38%(104/141), 63.6%(98/154), 60.8%(62/102) and 47.5%(29/61), respectively (P = 0.004). Conclusion cART was associated with decreased FIB-4 scores and the benefit of cART in reversing liver fibrosis can sustain for a decade in patients with HIV/HBV co-infection.
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Takeshima, Ryosuke, Masahiro Kamata, Shoya Suzuki, et al. "Interleukin‐23 inhibitors decrease Fibrosis‐4 index in psoriasis patients with elevated Fibrosis‐4 index but not inteleukin‐17 inhibitors." Journal of Dermatology, May 28, 2024. http://dx.doi.org/10.1111/1346-8138.17277.
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AbstractRecent studies indicate that hepatic diseases are associated with psoriasis. Non‐invasive tests, including the Fibrosis‐4 (FIB‐4) index, which can confidently rule out the presence of advanced fibrosis, are currently receiving attention. However, data on the FIB‐4 index in psoriasis patients and the effects of biologics on the FIB‐4 index are limited. We investigated the relationships between the FIB‐4 index and demographic or clinical characteristics as well as the effects of biologics on the FIB‐4 index in psoriasis patients. Psoriasis patients aged 36–64 years, whose treatment was initiated with interleukin (IL)‐17 inhibitors or IL‐23 inhibitors for psoriasis from May 2015 to December 2022, were consecutively included. Data were collected retrospectively from the patients' charts. A total of 171 psoriasis patients were included in this study. Thirty‐four, 43, 21, 32, and 41 psoriasis patients were treated with secukinumab, ixekizumab, brodalumab, guselkumab, or risankizumab, respectively. In biologics‐naïve patients, a significant but weak positive correlation was observed between the FIB‐4 index and age (r = 0.3246, p = 0.0018). There was no significant correlation between the FIB‐4 index and other demographic or clinical characteristics. Regarding the effects of biologics on the FIB‐4 index, no significant change was observed in psoriasis patients treated with any biologics. However, in psoriasis patients with a baseline FIB‐4 index of >1.3, patients treated with guselkumab and those treated with either IL‐23 inhibitor showed significantly decreased FIB‐4 index scores 6 months after initiating the biologics (p = 0.0323, p = 0.0212). In contrast, no change was observed in FIB‐4 index scores in patients treated with IL‐17 inhibitors. In conclusion, our study revealed that the FIB‐4 index was correlated with age in psoriasis patients. Furthermore, IL‐23 inhibitors (but not IL‐17 inhibitors) decreased the FIB‐4 index score at 6 months in psoriasis patients with elevated FIB‐4 index scores at baseline. Further studies are needed to clarify whether IL‐23 inhibitors improve liver fibrosis physiologically and functionally.
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Liu, Xiao, Hong‐Jin Zhang, Chang‐Chang Fang, et al. "Association Between Noninvasive Liver Fibrosis Scores and Heart Failure in a General Population." Journal of the American Heart Association, November 7, 2024. http://dx.doi.org/10.1161/jaha.123.035371.
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Background The association between nonalcoholic fatty liver disease and cardiovascular disease is firmly established, yet the association between noninvasive liver fibrosis scores and cardiovascular events remains a topic of uncertainty. Our study aimed to explore the association between liver fibrosis and heart failure. Methods and Results The data set was from the National Health and Nutrition Examination Survey 2011 to 2018. Advanced hepatic fibrosis risk was assessed through 3 noninvasive liver fibrosis scores: Fibrosis‐4 score (FIB‐4), the nonalcoholic fatty liver disease fibrosis score (NFS), and the aspartate aminotransferase to platelet ratio index (APRI). We included 19 695 eligible participants. The national prevalence of advanced liver fibrosis risk in the United States was 4.20%, 8.06%, and 0.35% as determined by FIB‐4, NFS, and APRI scores, respectively. Weighted logistic regression analysis revealed significant associations between advanced liver fibrosis risk and the prevalence of heart failure (continuous variables, FIB‐4: odds ratio [OR], 1.15 [95% CI, 1.07–1.23]; NFS: OR, 1.42 [95% CI, 1.23–1.64]; APRI: OR, 1.44 [95% CI, 1.15–1.81]). When the scores were assessed as categorical variables, the results were still significant (FIB‐4 ≥2.67 versus FIB‐4 <1.3: OR, 2.18 [95% CI, 1.47–3.24]; NFS ≥0.675 versus NFS <−1.455: OR, 2.53 [95% CI, 1.37–4.68]). Subgroup analysis found that the association between APRI and heart failure was stronger in female patients. Conclusions In the general US population, the prevalence of advanced liver fibrosis risk varied between 0.35% and 8.06% as indicated by noninvasive liver fibrosis scores. FIB‐4, NFS, and APRI scores were linked to an elevated prevalence of heart failure.
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Green, Victoria, Joanne Lin, Morgan McGrath, et al. "FIB-4 Reliability in Patients With Severe Obesity." Journal of Clinical Gastroenterology, November 3, 2023. http://dx.doi.org/10.1097/mcg.0000000000001937.
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Background: Liver biopsy is the gold standard to evaluate hepatic fibrosis; however, it has many drawbacks, especially in patients with severe obesity. Noninvasive testing such as the FIB-4 score is increasingly being used as the initial screening tool to identify patients at risk for advanced fibrosis. The broader applicability of FIB-4 and the precision of its cutoff values remain uncertain in metabolic dysfunction-associated steatotic liver disease and patients with severe obesity. Our study explored the correlation between FIB-4 scores and intraoperative liver biopsy in patients with severe obesity undergoing bariatric surgery. Methods: A total of 632 patients with severe obesity underwent preoperative vibration-controlled transient elastography and intraoperative liver biopsy during bariatric surgery from January 2020 to August 2021. Variables collected included patient demographics, laboratory values, abdominal ultrasound, vibration-controlled transient elastography, and liver biopsy results. ANOVA 1-way test, χ2 tests, and Fisher exact tests were used for quantitative and qualitative variables, respectively. The 95% CIs for the mean FIB-4 scores were used to generate surrogate cutoff values. The proposed FIB-4 cutoffs for F0-1, F2, F3, and F4 were 0.62 (CI: 0.59, 0.64), 0.88 (0.74, 1.01), 1.24 (0.94, 1.54), and 1.53 (0.82, 2.24), respectively. Area under the curve (AUC) methods were used to compare traditional to proposed cutoff values. Results: Applying the traditional FIB-4 cutoffs to approximate advanced fibrosis yielded an AUC of 0.5748. Use of the proposed FIB-4 cutoffs increased the AUC to 0.6899. The proposed FIB-4 cutoffs correctly identified 40 patients with biopsy-proven advanced fibrosis (F3-F4), all of which would have been missed using traditional cutoffs. Conclusion: Our study revealed that the use of the currently accepted FIB-4 cutoffs as the screening modality for identifying patients with advanced fibrosis due to metabolic dysfunction-associated steatotic liver disease is insufficient and will result in missing patients with histologically confirmed advanced fibrosis. Use of the revised FIB-4 scores should be considered to diagnose patients with severe obesity at high risk of liver disease progression.